Parenthood and gender differences in French GPs' labour supply responses to declining physician density: panel fixed-effects evidence.

BACKGROUND: Declining physician density threatens access to primary care. Although physicians may adjust their labour supply in response to local shortages, little is known about the extent of these adjustments and the role of family circumstances in shaping them. OBJECTIVE: To examine how French self-employed GPs adjust their labour supply to declining physician density and whether family circumstances explain observed gender differences. METHODS: We analyse a representative 4.4% panel of 2898 self-employed French GPs observed from 2010 to 2017 (INSEE Permanent Demographic Sample matched with tax and territorial data). Labour supply is proxied by private practice income. Physician fixed-effects models relate income to local physician density, controlling for individual, household and territorial characteristics. Heterogeneity analyses consider gender and family composition. RESULTS: A 10% decrease in GP density is associated with a 1.7-1.8% increase in private practice income (p < 0.01), indicating partial labour supply adjustment. Male GPs increase income by about 2.2% (p < 0.01), whereas no significant response is observed among female GPs overall. Among physicians without dependent children, however, responses are similar for men (+2.4%) and women (+1.9%) (both p < 0.01), suggesting that gender differences primarily reflect unequal family responsibilities during the child-rearing years rather than gender itself. CONCLUSIONS: Self-employed GPs partially adjust their labour supply to declining physician density, but these responses vary with family circumstances. Policies improving access to primary care should therefore complement workforce planning with measures that facilitate the reconciliation of professional and family responsibilities.